America’s 150-Year Opioid Epidemic

A bottle of laudanum, a highly addictive liquid preparation of opium widely used as a painkiller and sleep aid in the late 19th century.CreditCreditCountry Doctor Museum, East Carolina University

After the death of her father, a prominent hotel owner in Seattle, Ella Henderson started taking morphine to ease her grief. She was 33 years old, educated and intelligent, and she frequented the upper reaches of Seattle society. But her “thirst for morphine” soon “dragged her down to the verge of debauchery,” according to a newspaper article in 1877 titled “A Beautiful Opium Eater.” After years of addiction, she died of an overdose.

In researching opium addiction in late-19th-century America, I’ve come across countless stories like Henderson’s. What is striking is how, aside from some Victorian-era moralizing, they feel so familiar to a 21st-century reader: Henderson developed an addiction at a vulnerable point in her life, found doctors who enabled it and then self-destructed. She was just one of thousands of Americans who lost their lives to addiction between the 1870s and the 1920s.

The late-19th-century opiate epidemic was nearly identical to the one now spreading across the United States. Back then, doctors began to prescribe a profitable and effective drug — morphine, taken via hypodermic needle — too liberally. After a decade of overprescribing it for minor ailments and even for issues related to mental illness, a colony of American junkies began to emerge.

Most started out like Ella Henderson, who suffered from emotional trauma and chronic pain, for which she was prescribed copious amounts of morphine. She became addicted, was abandoned by the medical community and judged by her neighbors, and ultimately overdosed alone in her room. Her case mirrors the thousands of fentanyl and heroin overdoses that led President Trump in October to declare opioid abuse a public health emergency.

This first outbreak, typically traced to the popularization of hypodermically injected morphine, began to spread in the wake of the Civil War. It was finally contained by state and federal legislation like the Pure Food and Drug Act of 1906, the Harrison Anti-Narcotic Act of 1914 and the Heroin Act of 1924.

But addiction did not go away. Pushed underground during the 1930s and ’40s, widespread abuse re-emerged in the late 1950s and lasted through the 1970s, although in a less severe form than it had in the late 19th century. This time, the answer to the epidemic was a flurry of bills to regulate doctors and pharmacies, or control the dissemination of drugs, while also striking at the overall supply. It worked for the most part, but yet again did not end America’s turbulent relationship with drugs.

In response to a limited legal supply, heroin, cocaine and morphine continued to hold sway in the black-market economies of the streets and side alleys. The government responded by adopting a far more punitive approach to the problem, one centered on incarceration and policing. Over a century after Ella Henderson’s overdose, American cities suffered from a crack-cocaine epidemic that, as it waned, gave way to our current — and decidedly rural — heroin and fentanyl problem.

In the case of the opioid epidemic, history is literally repeating itself. Once again, too many Americans are dying of drug overdoses, and too many already vulnerable communities are being torn apart. Like our predecessors at the turn of the last century, we are asking what can be done to change the situation. Unlike them, we already know the answers. They solved the quandary for us.

First, we must hold doctors accountable — with fines and possible jail sentences — for overprescribing habit-forming drugs in the interest of profits. That was one of the immediate steps taken in the wake of stories like Henderson’s, and it quickly showed results.

We also must understand that if our nation’s health care remains a privatized, for-profit industry, the incentive to sell potent drugs to addicts will always exist. The health care industry was largely unregulated in the late 19th century; “buyer beware” applied to quack cures as much as to medical advice, and at first there was nothing the government could do to prevent doctors from overprescribing morphine.

Eventually, though, legislators stepped in with regulations on morphine and other products. And even though the health care industry is no longer the Wild West, we have lost our appreciation of the power of regulation to stop drug epidemics.

There are also lessons that need to be unlearned. While physicians and politicians of the late 19th century made significant progress in arresting the worst features of the opiate epidemic, they tended to overreact when it came to the context of the epidemic. This led to a shameful media campaign against Chinese immigrants, who often kept opium dens, and the demonization of Italians, Russian Jews, African-Americans, Mexicans, teenagers, musicians — anyone who, according to stereotypes, was among the typical abusers. We do the same today, at our peril.

They also allowed the campaign against opium to justify a general attack on all drugs, even those that present a much lower risk to public health. We are only now beginning to roll back excessive laws on cannabis, for example, because it is painfully clear that the reasons behind its prohibition had more to do with racial prejudice and social hysteria than with public health concerns.

Too often we imagine that our opioid crisis is new; the fact that it has been around, to varying degrees, for 150 years is a frustrating, even heartbreaking thought. But we can also take inspiration from the fact that we have tackled the problem before, and have won.

The difficult part is developing the will to confront the powerful interests that drive overprescription on one hand and overcriminalization on the other. We need politicians willing to impose new laws and to regulate the pharmaceutical and medical marketplaces in a far more disciplined way. This typically happens at the local level first and gradually makes its way into national policy.

We have to maintain our emotional composure, avoid press hyperbole and abandon our impulse to racialize the issue. The tendency to incarcerate our problems often results in entire generations of less fortunate Americans leaving high school for jail. If we do not know our drug history, we can be sure there will be many more Ella Hendersons in our future.